Anatomic Considerations Of Maxillary Anesthesia

Question 1

Whats Sensory innervation of maxillary teeth?

Answer 1

THE MAXILLARY NERVE, WHICH IS THE 2ND DIVISION OF TRIGEMINAL NERVE CARRIES SENSORY FIBERS TO THE TEETH OF MAXILLARY DENTAL ARCH.
Anteriosuperior alveolar nerve supply maxillary incisors and canine tooth and also buccal soft tissue of Incisors and canine.
Middle superior alveolar nerve supply maxillary premolar and portion of first molar tooth and buccal soft tissue of premolars.
Posterosuperior alveolar nerve supply maxillary molars except for a portion of first molar tooth and also supply buccal soft tissues of molars.

Anterior palatine nerve/Greater Palatine Nerve supply lingual soft tissue of molar and premolars.
Nasopalatine nerve supply lingual soft tissues of incisors and canines.

Question 2

Types of local anesthesia techniques

Answer 2

TOPICAL OR SURFACE ANESTHESIA
Local infiltration.
Nerve block.
Field block.

Question 3

Whats Topical/Surface Anesthesia?

Answer 3

IF CERTAIN LOCAL ANESTHETIC SOLUTION ARE APPLIED TO INTACT MUCOUS MEMBRANE ,THEY PASS THROUGH THE EPIDERMIS AND ANESTHETIZE THE NERVE ENDINGS KNOWN AS TOPICAL OR SURFACE ANESTHESIA.

Question 4

Whats Local Infilteration?

Answer 4

Anesthetic solution DEPOSITED NEAR THE TERMINAL FIBERS OR ANY NERVE WILL INFILTRATE THROUGH THE TISSUES TO REACH THE NERVE FIBERS AND THUS PRODUCE ANESTHESIA OF THE LOCALIZED AREA SERVED BY THEM.

Question 5

Block Anesthesia ?

Answer 5

ANESTHETIC SOLUTION NEAR A NERVE TRUNK WILL WORK BY BLOCKING ALL IMPULSES,PRODUCE ANESTHESIA OF AREA SUPPLIED BY THAT NERVE.THIS IS CALLED AS REGIONAL OR BLOCK ANESTHESIA.
MAY BE USE IN MAXILLA BUT IT IS OF PARTICULAR VALUE FOR PRODUCING ANESTHESIA IN MANDIBLE

Question 6

INFILTRATION TECHNIQUE IS FURTHER SUBDIVIDED INTO:
Hint: Go from outside to inside

Answer 6

. SUBMUCOUS INJECTION
.SUPRA-PERIOSTEAL INJECTION
.SUB-PERIOSTEAL INJECTION
.INTRA-OSSEOUS INJECTION
.INTRA-SEPTAL INJECTION

Question 7

Nerve blocks in Maxilla?

Answer 7

Posterior superior alveolar nerve block.
Middle superior alveolar nerve block.
Anterior superior alveolar nerve block.
Maxillary (2nd division ) nerve block.
Greater (anterior) palatine nerve block.
Nasopalatine nerve block

Question 8

Indications of supra periosteal Injection?

Answer 8

Pulpal anesthesia of one or two maxillary teeth.

Soft tissue anesthesia when indicated.

Hemostasis

Question 9

Contraindications Of Supra periosteal injection in Maxilla?

Answer 9

Infection or acute inflammation in area.
Dense bone covering the apices of tooth.

Question 10

Advantages Of Supra periosteal Injection?

Answer 10

High success rate (>95%).
Technically easy injection.
Usually entirely atraumatic

Question 11

Disadvantage Of supra periosteal injection?

Answer 11

Not suitable for large area
: multiple needle injection
:large volume of anesthetic solution

Question 12

Indications of pdl injection?

Answer 12

When conventional anesthesia is not fully effective.

When dentist want only short duration of anesthesia.

When patient wants to avoid lip and tongue anesthesia.

Question 13

Contraindications of PDL injection is?

Answer 13

Not indicated for primary teeth because it can cause enamel hypoplasia and hypomineralization of permanent teeth adjacent to injected site.

Not use in presence of gingival inflammation.

Question 14

Advantages Of PDL injection?

Answer 14

Its limited effects permit single tooth procedures

Minimize discomforts

Avoids hematoma formation

Avoids numbness of tongue, lips and other soft tissues thus minimizes the risk of self trauma.

Question 15

Disadvantages Of PDL injection?

Answer 15

Patient often experiences unpleasant bitter taste in mouth when the injection is given.

Glass anesthetic cartridge may shatter during injection due to use of excessive pressure or too rapid injection.

Slight extrusion of anesthetize teeth may occur following pdl injection

Question 16

Whats Intraseptal injection and when it is indicated?

Answer 16

The intraseptal injection is a type of local anesthesia where the solution is injected into the interdental septum — the bone between two teeth (specifically, in the papillary area just below the gum line).

It’s considered a modified version of the intraosseous injection because the anesthetic is placed directly into cancellous bone (spongy bone) through the thin septum.

✅ When Is It Used?
When conventional techniques fail to give complete numbness (e.g., in inflamed or infected areas).

When an immediate denture is being placed and supraperiosteal injections should be avoided (to prevent distortion of soft tissues).

When localized anesthesia is needed with minimal soft tissue numbness.

Question 17

PSA block is also called ?

Answer 17

Tuberosity Block/Zygomatic Block

Question 18

PSA block technique?

Answer 18

Start
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🧍 Position Patient
- Supine or semi-supine
- Head tilted slightly to opposite side
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🧼 Prepare Injection Site
- Dry with gauze
- Apply topical anesthetic for 1 minute
│
▼
📍 Identify Landmarks
- Mucobuccal fold above maxillary 2nd molar
- Zygomatic process
- Maxillary tuberosity
│
▼
💉 Insert Needle
- 16 mm depth (short needle)
- Upward (45° to occlusal plane)
- Inward (45° to midsagittal plane)
- Backward (45° to long axis of tooth)
│
▼
🩸 Aspirate
- Check for blood to avoid intravascular injection
- If positive, reposition
│
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💉 Inject Anesthetic
- Slowly inject 0.9–1.8 mL of solution over 30–60 seconds
│
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🕒 Wait for Onset
- 3 to 5 minutes for full effect
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🦷 Anesthesia Achieved
- Maxillary molars (except MB root of 1st molar in 28% of cases)
- Buccal periodontium and bone
│
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End

Question 19

Indications Of Tuberosity Block/Zygomatic Block/PSAN block?

Answer 19

When treatment involves two or more maxillary molars.

When supraperiosteal injection is contraindicated or ineffective.

Question 20

Contraindications Of PSAN block?

Answer 20

When risk of hematoma is too high (as in hemophilic) in which case a supraperiosteal or pdl injection is indicated.

Question 21

Advantages Of PSAN block?

Answer 21

Atraumatic.
High success rate
Less number of injection
Minimal amount of local anesthesia is used.

Question 22

Disadvantages Of PSAN block?

Answer 22

Risk of hematoma.

Donot anesthetize first molar completely……

No bony landmark during insertion.

Second injection nessesary for first molar in 28% of patient.

Question 23

MSAN block technique flowchart?

Answer 23

Start
│
▼
🧍 Position the Patient
- Supine or semi-supine
- Head tilted slightly toward the operator
│
▼
🧼 Prepare Injection Site
- Dry area with gauze
- Apply topical anesthetic for ~1 minute
│
▼
📍 Identify Landmarks
- Mucobuccal fold above maxillary 2nd premolar
│
▼
💉 Insert Needle
- Insert into height of mucobuccal fold above 2nd premolar
- Angle needle parallel to long axis of tooth
- Penetrate ~5–10 mm
│
▼
🩸 Aspirate
- Check for blood return
- Reposition if positive
│
▼
💉 Inject Anesthetic
- Inject 0.9–1.2 mL of anesthetic slowly
│
▼
🕒 Wait for Onset
- 3–5 minutes for full anesthetic effect
│
▼
🦷 Anesthesia Achieved
- Maxillary premolars
- MB root of 1st molar (if innervated by MSAN)
- Buccal gingiva and bone in that region
│
▼
End

Question 24

Which areas are anesthesized by MSAN block?

Answer 24

Area to be anesthetize is 1st and 2nd premolar and mesiobuccal root of first molar along with buccl periodontium and bone covering these teeth

Question 25

Indications Of MSAN block

Answer 25

When infraorbital nerve block fails to provide pulpal anesthesia distal to maxillary canine. Dental procedure involving both maxillary premolar

Question 26

Contraindications?

Answer 26

Infection and inflammation in area of injection Where msa nerve is absent.

Question 27

ASAN block ?

Answer 27

Also known as infraorbital nerve block It anesthetize asa and infraorbital nerve. Area anesthetize is pulp of maxillary central incisor through canine on injected side. Buccal periodontium and bone of these teeh Lower eyelid, lateral aspect of nose and upper lip

Question 28

Indications Of ASAN block/Infra orbital nerve block?

Answer 28

Dental procedure involving more than two maxillary teeth and overlying buccal tissue. Inflammation and infection (which c/I supraperiosteal injection) When supraperiosteal injection is ineffective because of dense cortical bone.

Question 29

ASAN TECHNIQUE Flowchart?

Answer 29

Position patient (chin slightly up) Apply topical anesthesia Palpate infraorbital foramen Insert needle toward foramen (approx. 16 mm deep) Aspirate, then inject 0.9–1.2 mL slowly Apply finger pressure over foramen Wait 3–5 mins for onset

Question 30

Greater palatine nerve block ?

Answer 30

This block anesthetize the posterior portion of hard palate and overlying tissues anteriorly as far as 1st premolar and medially to the midline.

Question 31

Contraindications Of Greater Palatine Nerve Block?

Answer 31

Small area of therapy Inflamation and infection at the injection side.

Question 32

Advantages Of Greater Palatine nerve block ?

Answer 32

Minimize needle penetration Minimize volume of solution Minimize patient discomfort

Question 33

Disadvantages Of Greater Palatine Nerve Block?

Answer 33

No hemostasis except in immediate area of injection Potentially traumatic

Question 34

Greater palatine nerve block technique?

Answer 34

Start ↓ 🧍 Position the Patient → Supine with neck extended → Head turned toward the operator ↓ 🧼 Prepare the Injection Site → Dry the palate with gauze → Apply topical anesthetic for ~1 minute ↓ 📍 Locate Landmarks → Identify the **greater palatine foramen** → Located ~1 cm medial to the 2nd molar at junction of alveolar process and hard palate → Use cotton swab to apply pressure to locate depression ↓ 💉 Insert the Needle → Use a short needle (27G recommended) → Insert at a **right angle (90°)** to the palate → Penetrate just until bone is contacted (~4–6 mm) ↓ 🩸 Aspirate → Pull back slightly to check for blood → If positive, reposition and re-aspirate ↓ 💉 Inject the Anesthetic → Inject **slowly** (0.25–0.5 mL max) → Slight blanching of the palate confirms correct placement ↓ 🕒 Wait for Onset → Onset in **2–3 minutes** ↓ 🦷 Areas Anesthetized → Posterior part of hard palate → Soft tissue from **distal of canine to soft palate** (medially) → No effect on teeth themselves ↓ End

Question 35

Nasopalatine Nerve Block Anesthesize Which areas?

Answer 35

It anesthetize anterior portion of hard palate, hard and soft tissue from mesial of right 1st premolar to mesial of left 1st premolar

Question 36

Indications Of Nasopalatine Nerve Block?

Answer 36

To supplement the block of asa and msa nerve To augment the analgesia of six maxillary incisor To complete anesthesia of maxillary septum. 1️⃣ To Supplement the Block of ASA and MSA Nerves 🦷 The ASA (Anterior Superior Alveolar) and MSA (Middle Superior Alveolar) blocks anesthetize: Maxillary incisors, canines, and premolars Their buccal (outer) soft tissues ❗However: They do not anesthetize the palatal (inner) side of the hard palate. ✅ Nasopalatine block is given to cover the palatal mucosa and bone behind the maxillary incisors and canines — areas ASA/MSA don’t reach. 2️⃣ To Augment the Analgesia of Six Maxillary Incisors 🦷 If you're working on the six front teeth (central + lateral incisors, canines), you need: Buccal anesthesia → ASA block Palatal anesthesia → Nasopalatine block ✅ This block ensures the entire anterior hard palate (from canine to canine) is numb, making procedures like extractions, flap surgery, or deep restorations more comfortable. 3️⃣ To Complete Anesthesia of the Maxillary Septum 📌 The nasopalatine nerve also innervates: The nasal septum The anterior part of the hard palate (especially the incisive papilla area)

Question 37

Disadvantages Of Nasopalatine Nerve Block?

Answer 37

No hemostasis except for immediate area of injection Potentially most traumatic intraoral injection

Question 38

Maxillary Nerve block anesthesize which areas?

Answer 38

✅ So, it anesthetizes: All maxillary teeth on one side only (from central incisor to third molar) Buccal and palatal gingiva on that same side Upper lip, cheek, nose, lower eyelid — also only on that side 🔄 If you need both sides numb: You would have to perform two separate V2 blocks, one on each side.

Question 39

Indications Of Maxillary Nerve Block?

Answer 39

Pain control before extensive oral surgical, periodontal and restorative procedures requiring anesthesia of entire maxillary division. Inflamation and infection Diagnostic and therapeutic procedure for neuralgia and tics of 2nd division of trigeminal nerve.